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Chylothorax After Single-Chamber Implantable Cardioverter-Defibrillator Extraction
Marco Radaelli1, Mohammad Saad Husain1, Julian Armijo-Alba1
1Internal Medicine Teaching Service, MedStar Washington Hospital Center/Georgetown, Washington, DC, USA.
JACC. Case Reports
|June 6, 2025
Summary
Cardiac implantable electrical device (CIED) lead extraction can rarely cause chylothorax, a serious complication. Early recognition and management are vital for patient outcomes.
Area of Science:
- Cardiology
- Thoracic Surgery
- Critical Care Medicine
Background:
- Cardiac implantable electrical device (CIED) lead extraction is a common procedure, with approximately 15,000 cases annually.
- While generally safe, CIED lead extraction carries risks of potential complications that necessitate awareness for optimal patient management.
Observation:
- A 63-year-old male with multiple comorbidities underwent implantable cardioverter-defibrillator lead extraction due to device pocket infection.
- Following the procedure, the patient experienced progressive hypoxic respiratory failure and a new right-sided pleural effusion, diagnosed as chylothorax.
Findings:
- This case represents the first reported instance of chylothorax occurring after CIED lead extraction.
- Despite initial conservative management, the patient's condition worsened, culminating in cardiac arrest and death.
Implications:
- Chylothorax should be considered in the differential diagnosis for patients presenting with new pleural effusions post-CIED lead extraction.
- Prompt recognition and timely, appropriate management of rare complications are critical, particularly in high-risk patient populations undergoing CIED lead extraction.
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